Dowel pinning for feline metacarpal and metatarsal fractures.

The goal of this retrospective study was to describe dowel pinning, and to compare the results of osteosynthesis and external coaptation of metacarpal and metatarsal fractures in cats. Evaluation of the medical records of 351 cats yielded 63 cats treated with dowel pinning, 35 cats treated with external coaptation and 14 cats treated with both methods within the same limb. All of the cats had been re-evaluated at an average of 2.8 years (six months - 15 years) postoperatively. Dowel pinning was superior to external coaptation when all fractured bones of a limb could be pinned. When internal fixation of multiple fractures was not feasible in all fractured bones due to comminution or fragments that were too short to pin, the outcome was not significantly different from cases treated with external coaptation alone. Malunion was seen in 16% of fractured bones in cats treated with external coaptation and occurred secondary to implant bending in 3% of fractured bones treated with dowel pinning. The latter refers to one operated cat, which had four metacarpal fractures in the same limb. Radiographs taken at re-evaluation showed implant migration within the medullary canal in two cats, although neither showed any signs of non-union or lameness. Non-union was seen in one operated cat, in which the fracture (MC IV) could not be completely reduced with a K-wire. Osteomyelitis did not occur. Dowel pinning is an easy, inexpensive and effective technique for repair of metacarpal and metatarsal fractures in cats.     

Long-term results of transarticular pinning for surgical stabilisation of coxofemoral luxation in 20 cats

O bjectives : The objective of this study was to describe initial and long-term results of open reduction and transarticular pinning for treatment of coxofemoral luxations in cats.
M ethods : Cats were treated by open reduction and transarticular pinning for coxofemoral luxation over a five year period at two institutions. Follow-up assessment included orthopaedic examination, radiography and owner questionnaires.
R esults : Twenty cats were included in the study (14 males and six females). One cat was affected bilaterally. Mean time to follow-up was 21 months. Seventeen joints were stabilised with a 1·6 mm pin, three with 2·0 mm pins and a 1·2 mm pin was used in the remaining joint. An Ehmer sling was not utilised in any case. All transarticular pins except one were removed (mean 3·5 weeks), with all hips still in reduction The overall success rate was 77 per cent, with two reluxations and one resorbed femoral head noted on radiographs of 13 joints followed long term. All 20 owners reported good to excellent long-term functional outcome for their cats.
C linical S ignificance : Results from this study indicate that transarticular pinning for stabilisation of coxofemoral luxation in cats can provide a good long-term outcome without sacrificing the integrity of the coxofemoral joint.     

Surgical versus conservative management of patella fractures in cats: a retrospective study

This study compared the clinical outcome in cats with patella fractures treated by surgery to those treated conservatively. Six cats with 9 patella fractures were treated. Six fractures were treated surgically and 3 were treated conservatively. Medical records of all 6 patients were reviewed for age, breed, gender, trauma, and fracture conformation. All patients had follow-up which consisted of a physical examination, radiographs, and an interview with the client between 1 and 4.5 y after surgery or diagnosis. All cats treated conservatively returned to normal activity with no gait abnormalities. In cats that had surgery, 4/6 had breakdown of the surgical repair but all cats went on to full recovery with normal activity and gait. The conclusions of this preliminary study are that surgical repair of cat patella fractures has a high rate of implant failure and that conservative management of cat patella fractures results in excellent clinical outcome.     

Comminuted long bone fractures in cats caused by pneumatic gun shot and repaired using the external fixator "tie-in" technique

Five cats with femoral fractures caused by pneumatic gun shot wounds were treated using intramedullary pin/external skeletal fixation "tie-in" (IM/ESF tie-in) technique between 1997 and 2005. Clinical and radiographical examinations were used to assess bone healing, limb function recovery and complications. Clinical results as well as fracture healing were excellent in all five cats. The study showed that the IM/ESF tie-in technique can be used in cats for the treatment of comminuted femoral fractures caused by pneumatic bullets.     

Correction of Rotational Deformity of the Pes with External Skeletal Fixation in Four Dogs

Objective— To report unilateral correction and initial stabilization with external skeletal fixation (ESF) of metatarsal rotation in 4 immature Bernese Mountain Dogs.
Study Design— Case series.
Animals— Bernese Mountain Dogs (n=4).
Methods— The limb deformity, including degree and origin of the deformity at the level of the proximal intertarsal joint and involvement of the central tarsal bone, was characterized by clinical and radiographic assessment. Unilateral surgical correction of the most severely affected limb was performed by disrupting the ligaments and debriding the articular cartilage of the proximal intertarsal joint to allow for derotation of the deformity and arthrodesis of the proximal intertarsal joint stabilized with either circular or linear ESF.
Results— Initial metatarsal rotation of the corrected limbs ranged from 60° to 80° of external rotation (mean, 72.5°). Three limb corrections were stabilized with circular ESF and 1 with a biplanar linear ESF. Implants were removed at the time of radiographic bony union (range, 7–10 weeks; mean, 8.6 weeks). Residual deformity was minimal, ranging from 6° to 15° (mean, 11°). Two minor complications (loosening of 1 pin, serous drainage from 1 pin) resolved with treatment.
Conclusion— Correction of rotational deformity of the pes with intertarsal arthrodesis yielded an excellent clinical outcome, with only a mild residual deformity.
Clinical Relevance— Rotational metatarsal deformities can have a significant impact on gait, ambulation, and appearance. Correction of these deformities and stabilization with ESF and intratarsal arthrodesis can yield an excellent functional outcome, with improved gait and ambulation.     

Toggle rod stabilisation of coxofemoral luxation in 14 cats

Objectives : To describe the surgical technique and to report outcomes in cats with coxofemoral luxation treated with open reduction and toggle rod stabilisation. Methods : Retrospective study of cats with coxofemoral luxation stabilised via the toggle rod method. Short‐term follow‐up included clinical examination and radiographs. Long‐term follow‐up was via owner questionnaire. Results : Fourteen cats were included. All of the cats had reported unilateral craniodorsal hip luxation. Nine cats (64·3%) had additional orthopaedic injuries. Luxations were stabilised with a 3·2‐mm toggle rod (2·7‐mm toggle rod in one cat) and two loops of four‐metric polydioxanone (five‐metric polydioxanone in one cat and three loops of four‐metric polydioxanone in two cats). Success rate, in terms of maintenance of reduction, was 86%. Reluxation occurred in two cats (14%), both of which had multiple limb injuries. Eleven owner questionnaires (mean follow‐up time 15·5 months) reported a functional outcome of “very good” to “excellent”. Although the diameter of the pelvic canal was reduced by the presence of the toggle rod (mean narrowing 16.2%), none of the cats had defaecatory issues. Clinical Significance : Toggle rod stabilisation is an effective method for the treatment of coxofemoral luxation in cats. Injuries to multiple limbs may be a risk factor for reluxation.     

Feline Ilial Fractures: A Prospective Study of Dorsal Plating and Comparison with Lateral Plating

Objective— To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate.
Study Design— Prospective study.
Animals— Cats (n=10) with iliac fractures.
Methods— Cats with ilial fractures (January 2005–December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4–6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats.
Results— Mean (± SD) screw purchase (89 ± 11 mm) was significantly greater ( P <.01) with a dorsal plate compared with a lateral plate (33 ± 8 mm). Significantly more screws ( P <.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4–6-week follow-up radiography compared with the LP group (2% versus 15%, P <.01).
Conclusion— Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4–6 weeks after surgery compared with LP.
Clinical Relevance— Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.     

Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004)

OBJECTIVE: To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN: Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES: Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS: In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.     

Distal Interphalangeal Joint Arthrodesis in Seven Cattle Using the Acutrak Plus Screw

Objectives— To report a technique for arthrodesis of the distal interphalangeal joint (DIPJ) with two 6.5 mm Acutrak Plus (AP) compression screws from a solar approach and outcome in 7 cattle.
Study Design— Case series.
Animals— Cattle (n=7) with DIPJ arthritis.
Methods— Retrieved data from medical records of cattle that had undergone DIPJ arthrodesis using 2 AP screws via a solar approach were signalment, history, clinical signs, preoperative blood work, preoperative radiographs, complications, postoperative radiographs, and postoperative lameness evaluation. Outcomes, assessed by owner interview 6–26 months after surgery, were classified as excellent, good, or poor.
Results— Fusion of the DIPJ was evident by 6 months. All cattle returned to full function with minimal lameness and normal appearance to the distal aspect of the limb. Four thoracic limbs and 3 pelvic limbs were affected; 3 medial and 4 lateral claws. Complications included moderate lameness associated with implants (n=2) that resolved after screw removal.
Clinical Relevance— Use of the AP screw system in cattle is an excellent option for DIPJ arthrodesis with minimal postoperative morbidity and excellent return to function.     

Treatment of tibial fractures with plates using minimally invasive percutaneous osteosynthesis in dogs and cats

OBJECTIVES: The aim of the here described case series was to develop and evaluate the minimally invasive percutaneous osteosynthesis for the plate fixation of tibial fractures in dogs and cats. METHODS: Six dogs and four cats with shaft fractures of the tibia were treated using minimally invasive percutaneous osteosynthesis. Follow-up radiographs four to six weeks after fracture fixation were evaluated for fracture healing. For the long-term follow-up (minimum 2.4 years), owners were contacted by phone to complete a questionnaire. RESULTS: All fractures healed without the need for a second procedure. Follow-up radiographs obtained after four to six weeks in seven cases showed advanced bony healing with callus formation and filling of the fracture gaps with calcified tissue in all seven. All the patients had a good to excellent long-term result with full limb function. The time needed for regaining full limb use was two to three months. CLINICAL SIGNIFICANCE: Minimally invasive percutaneous osteosynthesis seems to be a useful technique for the treatment of tibial shaft fractures in dogs and cats.     

Minimally invasive plate fixation of lower limb injury in horses: 32 cases (1999-2003)

REASONS FOR PERFORMING STUDY: Complications of osteosynthesis including superficial and deep infections continue to affect adversely outcome in equine surgery of the lower limb. OBJECTIVE: To describe a technique for minimally invasive plate fixation in horses and evaluate clinical results of the technique. HYPOTHESIS: Lower complication rates would occur in horses treated with a minimally invasive approach compared with conventional techniques. METHODS: Cases of minimally invasive plate fixation from January 1999 to December 2003 were evaluated. Case records, radiographs and race records for horses that sustained distal third metacarpal/metatarsal (Mc/tIII) condylar fractures were assessed. Follow-up information was obtained and results analysed. In addition, results for horses that received arthrodesis by a conventional, open approach during the same period were evaluated and statistical analysis was performed. RESULTS: Thirty-two cases of minimally invasive plate fixation were identified (22 incomplete distal Mc/tIII condylar fractures with a spiralling or diaphyseal component, 10 metacarpophalangeal arthrodeses and 4 pastern arthrodeses). For both types of arthrodesis, surgery times and infection rates were lower and survival rates higher in the minimally invasive group, but no statistical difference was found. Spiralling condylar fractures were successfully managed, without catastrophic fracture. CONCLUSIONS AND POTENTIAL RELEVANCE: Minimally invasive percutaneous plate osteosynthesis (MIPPO) can be successfully used for select applications in horses, and may reduce morbidity and mortality in equine fracture repair.     

Segmental ostectomy of the second and fourth metacarpal and metatarsal bones in horses: 17 cases (1993-2002)

OBJECTIVE: To determine clinical findings in and outcome of horses with fractures of the second or fourth metacarpal or metatarsal bone that underwent segmental ostectomy, leaving the proximal and distal portions of the bone undisturbed. DESIGN: Retrospective case series. ANIMALS: 17 horses. PROCEDURES: Medical records were reviewed, and information on signalment, affected bone, lesion type, surgical procedure, amount of bone removed, and surgical and postsurgical complications was obtained. Follow-up information was obtained through telephone conversations with owners, trainers, and referring veterinarians. RESULTS: One horse had a fracture involving the distal third of the second metacarpal bone; 13 had fractures involving the middle third of the second metacarpal bone (n = 4), fourth metacarpal bone (5), or fourth metatarsal bone (4); and 3 had fractures involving the proximal third of the second (2) or fourth (1) metacarpal bone. Affected portions of the bones were surgically resected, leaving the proximal and distal portions undisturbed. All horses returned to previous performance levels without evidence of lameness. Cosmetic results were good to excellent. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that horses with a complicated injury of the proximal, middle, or distal portion of the second or fourth metacarpal or metatarsal bone may be successfully treated by means of segmental ostectomy of the abnormal portion of the bone.     

A Lateral Approach to the Repair of Propagating Fractures of the Medial Condyle of the Third Metacarpal and Metatarsal Bone in 18 Racehorses

Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.     

Use of the Kishigami Atlantoaxial Tension Band in Eight Toy Breed Dogs with Atlantoaxial Subluxation

Objective— To determine the applicability, complications, and long-term functional outcome of the Kishigami Atlantoaxial Tension Band (Kishigami AATB) for management of congenital and traumatic atlantoaxial (AA) instability in toy breed dogs.
Study Design— Case series.
Animals— Toy breed dogs (n=8) with congenital or traumatic AA instability.
Methods— The AA joint of each dog was surgically stabilized through a dorsal approach using the original or a modified version of the Kishigami AATB. Pre- and postoperative neurologic status, radiographs, and complications were reviewed. Follow-up examination was performed at 1 and 12 months.
Results— Functional improvement occurred in 5 dogs; 1 dog did not improve or worsen and 2 dogs were euthanatized at owner request. Adequate reduction and stabilization was achieved in 7 dogs based on immediate postoperative radiographs; failure of reduction was evident in 1 dog. No relevant complications occurred.
Conclusions— Kishigami AATB may be acceptable as an alternative method for dorsal stabilization of AA subluxation in toy breed dogs in which use of ventral screws or pins is challenging. Experience with this technique in a larger population is necessary to compare our results to those reported by ventral approach.
Clinical Relevance— The surgical technique described is effective, safe, and simple in the surgical treatment of AA subluxation in toy breed dogs.     

Use of a Medial Bone Plate for Repair of Radius and Ulna Fractures in Dogs and Cats: A Report of 22 Cases

Objective —This study evaluates the technique of medial bone plating in the repair of radius fractures in dogs and cats.
Study Design —A retrospective study was made of patients diagnosed with fractures of the radius that were stabilized by application of a bone plate to the medial side of the bone.
Animal Population —Sixteen client-owned dogs and 4 client-owned cats. The animals' ages varied from 5 months to 8 years, and their weight varied from 1.3 to 49 kgs.
Methods —Animals were evaluated using radiography or client assessment, or both.
Results —Medial plate application was technically easier to do than cranial plate application, the technique avoided the extensor tendons, and permitted greater versatility in the selection of smaller plates for the fixation of distal radius fractures. All fractures repaired by this method healed with no postoperative complications.
Conclusions —Medial plate application may be used for osteosynthesis of distal or middiaphy-seal radius fractures. Further studies are needed to evaluate the use of this technique in morphologically complex fractures. In patients with fractures of the proximal radius, cranial plate application is considered more appropriate.
Clinical Relevance —Medial plating of radial fractures has significant advantages compared with conventional plate application; it provides the surgeon with an alternative method of fixation for selected radius fractures in dogs and cats.     

The diagnostic yield of conventional radiographs and computed tomography in dogs and cats with maxillofacial trauma

Objective— To compare the diagnostic yield of conventional radiographs and computed tomography (CT) images of the skulls of dogs and cats with maxillofacial trauma (MFT).
Study Design— Prospective study.
Animals— Dogs (n=9) and 15 cats with MFT.
Methods— CT-scans and skull radiographs (4 standard projections) for each animal were evaluated using a semi-quantitative scoring system for the ability to identify 26 predefined, clinically relevant anatomic features (Part 1), and 27 predetermined potential traumatic injuries (Part 2). For Part 1, mean scores for each anatomic feature were recorded for every view and imaging modality. For Part 2, studies were evaluated for the frequency of cases where each predetermined traumatic injury was identified.
Results— Part 1: On radiographs it was easy to identify 17 of 26 anatomic features whereas 6 features were very difficult or impossible to identify on any view. All structures were considered easy or very easy to identify on CT. Scores for CT were lower than radiographs for evaluating dental occlusion and the integrity of the mandibular body. Part 2: CT scans demonstrated 1.6 times more maxillofacial injuries for dogs and 2.0 times more for cats than conventional radiographs. The average number of MFT injuries per animal by radiographs and CT-scan was 4.8 and 7.6 in dogs, and 3.8 and 7.7 in cats, respectively.
Conclusion— CT is superior to conventional skull radiography for identification of anatomic structures and traumatic injuries in dogs and cats. Skull radiography is useful for visualizing the mandibular body and dental occlusion.
Clinical Relevance— CT allows for accurate assessment, diagnosis and treatment planning of MFT in dogs and cats.     

Multiple Osteochondral Autografts for Treatment of a Medial Trochlear Ridge Subchondral Cystic Lesion in the Equine Tarsus

Objective— To adapt the multiple osteochondral autograft technique for treatment of a subchondral cystic lesion (SCL) of the proximal medial trochlear ridge (MTR) of the equine talus and assess long term outcome.
Study Design— Case report.
Animals— Quarter horse stallion with SCL of the proximal MTR of the talus.
Methods— Osteochondral autograft techniques used in dogs and humans were adapted and optimized in equine cadavers. A horse with a SCL of the MTR of the talus was treated by osteochondral autografting. Three osteochondral autografts were harvested from the distal lateral trochlear ridge of the talus in the affected tarsus. No curettage or debridement of the osteochondral lesion was performed. Three recipient beds were predrilled and osteochondral autografts were press-fit into the proximal MTR of the talus. Outcome was assessed by radiography, telephone interview of the owner, and direct observation during training.
Results— Postoperative radiographs indicated excellent filling of the osteochondral defect and graft-articular surface congruency. No complications were encountered after surgery. At 10 months after surgery, the horse successfully re-entered reining training, and continued to be sound and performing athletically 2 years after surgery.
Conclusion— Osteochondral autografting deserves consideration and further evaluation as a primary treatment option for SCL of the proximal MTR of the talus in horses.
Clinical Relevance— Based on the outcome of this case, osteochondral autografting appears to be a safe, valuable and realistic option for treating SCL of the proximal MTR of the talus in equine athletes.     

Separation of the Auricular and Annular Ear Cartilages: Surgical Repair Technique and Clinical Use in Dogs and Cats

Objective— To report a surgical technique for primary repair of separation of the annular and auricular cartilages of the ear and long-term outcome.
Study Design— Case series.
Animals— Cats (3) and dogs (2) with ear canal separation.
Methods— Medical records (1998–2007) of dogs and cats with ear canal separation were reviewed. Long-term outcome was obtained by telephone interview of owners or referring veterinarians.
Results— Three cats and 1 dog had ear canal separation after being hit by a car; there was no history of trauma in 1 dog. Successful repair was achieved by a caudal approach to the ear canal, identifying and debriding separated cartilage edges and using primary repair. A patent ear canal was confirmed in all animals by otoscopy 4–12 weeks later and by ear canalography in 3 animals. Long-term outcome was excellent with no reported complications 10–90 months later (median 24 months).
Conclusions— Both acute and chronic separation between the annular and auricular cartilages, in the absence of middle ear disease, can be successfully treated using primary repair via a caudal approach to the ear canal, with excellent long-term outcome.
Clinical Relevance— Primary repair should be considered in animals with separation of the annular and auricular cartilages.     

Metacarpal and metatarsal fractures in dogs

Metacarpal fractures were more common than metatarsal fractures in this retrospective study of 37 dogs. Fractures of one metacarpal or metatarsal bone occurred In 24 per cent of the dogs, two metacarpal bones in 16 per cent, three metacarpal or metatarsal bones in 19 per cent, and four metacarpal or metatarsal bones in 41 per cent. Eighty-seven per cent of the dogs with fractures of four bones had fracture displacement or malalignment of at least one digit. Progressive fracture healing usually occurred Irrespective of stabilisation method. For malaligned fractures, however, external coaptation did not consistently improve alignment. Fracture alignment was consistently Improved by open reduction and internal fixation of acute fractures with bone plates. Fractures of four bones occurred most often In the distal metacarpus as opposed to the proximal metatarsus. Therefore, open reduction and internal fixation may be more commonly indicated for severe metacarpal fractures, because fracture displacement or axial1 malalignment was significantly associated with fractures of the mid or distal regions of the metacarpus or metatarsus (P=0.052).